title: Ureteroscopy in children: is there a need for ureteral dilation and postoperative stenting?
abstract: BACKGROUND
  Ureteroscopic stone manipulation and extraction is the standard of care for distal stone disease in the adult population. Recently, with refinements in instrumentation, these standards have been applied in pediatrics. Here, we investigate the role of ureteral dilation and the need for postoperative stenting after ureteroscopy.
  
  
  METHODS
  Twenty-nine children (21 male, eight female) with a mean age of 11.0 (2.5-17.5) years underwent 34 ureterscopic procedures (21 right, 13 left) to address ureteral stones in 27 (23 distal, 3 mid and 1 proximal), surveillance of the upper tract in six and a retained stent in one. Active ureteral dilation was not required in any of these patients. A Wolfe 4.5-F or 6.5-F tapered semi-rigid ureterescope was passed alongside a previously placed guidewire to access the upper collecting system. Proximal ureteral surveillance was performed after completion of the procedure; all but two patients had a diagnostic ureterogram. Four patients had preoperative placement of a JJ stent. Postoperative stents were placed in six patients, two had stents placed preoperatively for infection associated with either autonomic dysreflexia or stone impaction, two for extravasation or perforation, one for edema and one for subsequent ESWL.
  
  
  RESULTS
  Mean follow up after ureteroscopy was 16.2 (0.3-48) months. Of the 27 procedures for stone disease, 15 (55%) stones required laser litholipaxy and 12 (45%) were managed with stone basket extraction. The overall re-treatment rate for stone disease was 4%. Diagnostic ureteroscopy was normal in six procedures. None of the procedures managed without a post-ureteroscopy stent required subsequent intervention.
  
  
  CONCLUSIONS
  Ureteroscopy is a safe, effective method to manage ureteral stones. Refinements in instrumentation allow its application to the pediatric population. Ureteroscopy including laser lithotripsy can be performed without ureteral dilation or postoperative stenting.
authors.affiliation: Section of Pediatric Urology, Division of Urology, Department of Surgery, University of Alabama at Birmingham, USA. anthony.herndon@ccc.uab.edu
authors.forename: C D Anthony
authors.initials: CD
authors.lastname: Herndon
authors.forename: Louis
authors.initials: L
authors.lastname: Viamonte
authors.forename: David B
authors.initials: DB
authors.lastname: Joseph